Basic Information
| Provider Information | |||||||||
| NPI: | 1972104321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATTERS | ||||||||
| FirstName: | AMARA | ||||||||
| MiddleName: | CAMILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 291 SHADS FORD BLVD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283141222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102603946 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5 DOWD CIR STE A | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283747932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102952609 | ||||||||
| FaxNumber: | 8009486061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2020 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 11193 | NC | Y |
No ID Information.